The World Health Organization (WHO) was set up in 1948 as the United Nations agency responsible for coordinating and providing leadership on matters related to health globally.
One of the functions of WHO is to set the norms and standards for the prevention, treatment and management of diseases and health conditions. To this end, it develops, through a consultative process, guidelines for the various diseases and conditions for both humans and animals.
In this post, I delve deep into WHO’s guidelines for postnatal care for mothers and particularly the guidelines for the mental health of new mothers after birth.
Key aspects of WHO’s post-natal care guidelines
The most recent WHO guidelines for post-natal care were published in January 2013 and can be accessed on this link: https://www.who.int/publications/i/item/9789241506649
The guidelines have twelve (12) key recommendations categorised into three:
- Provision of postnatal care to mothers and newborns
This category covers the first three recommendations which touch on: timing of discharge from a health facility after birth, number and timing of postnatal contacts, and home visits for postnatal care.
- Content of postnatal care for the newborn
This category covers recommendations 4 to 7, which touch on: assessment of the baby, exclusive breastfeeding, cord care, and other postnatal care for the newborn.
- Content of postnatal care for the mother
This category covers recommendations 8 to 12, which touch on: assessment of the mother, counselling, iron and folic acid supplementation, prophylactic antibiotics, and psychosocial support.
It is important to mention that the guidelines recommend at least four postnatal care visits (whether in a health facility or at home), between 24 hours and 6 weeks after birth, in the following intervals: 1 visit within 24 hours after birth, 1 visit on day 3 after birth, 1 visit between day 7 and 14, and another visit at 6 weeks.
Maternal mental health recommendations in WHO’s post-natal care guidelines
It is encouraging to note that the WHO’s guidelines for post-natal care recognise the importance of maternal mental health and have made several recommendations to address the issue.
These recommendations include:
- During the first postnatal contact, after the initial 24 hours after birth:
The guidelines recommend that healthcare providers should enquire from the mother about her emotional well-being, and what family or social support she has, as well as any coping strategy she is using to manage her emotions and the new demands.
The providers should also encourage the new mother and her partner or family to inform the healthcare professional of any changes in mood, emotional state and behaviour that seems out of the ordinary.
- At day 10-14 after birth:
The guidelines recommend that healthcare professionals should ask the new mother about her ability to resolve any mild or transitory postpartum depression (maternal blues) she may have had.
If the symptoms for maternal blues are still present, the healthcare professionals should assess the psychological well-being of the mother and if there is a concern, she should be evaluated for postnatal depression.
The mother should then be referred to the right healthcare professional for advice and management of postnatal depression, if confirmed.
- Other recommendations:
The guidelines also recommend the provision of psychosocial support by a trained professional for the prevention of postpartum depression but only to women who are at risk of developing postpartum depression. The authors argue that there is limited and weak evidence of the effectiveness of offering this support as well as educational content to all mothers who have given birth and only those at risk should be considered.
The guidelines further recommend additional psychosocial support to mothers who have lost their newborns.
Personal reflections
The WHO’s recommendations on identifying and addressing postnatal maternal mental health issues are strong and recognise the evolving nature of maternal mental health issues. For most new mothers, postnatal mental health issues start as maternal blues (or baby blues), which if not properly managed metamorphose into the more severe postnatal depression. Hence taking advantage of the early postnatal care contacts to discuss, assess, and manage maternal blues is a good recommendation.
The recommendation on providing psychosocial support as well as educational content to only high-risk mothers is a bit disappointing. This is because postnatal depression can affect any mother, whether high-risk or low-risk, including even mothers with great social support systems around them.
Additionally, lived experiences from new mothers show that maternal mental health issues can start at any point in time after birth, not necessarily immediately after birth. While for some, they start immediately after birth, for others it takes months – even up to two years – for the mental health issues to manifest.
Hence taking advantage of the early postnatal care visits/contacts to educate all new mothers on the signs and symptoms to watch out for and for the strategies to use to manage them would go a long way in creating awareness on maternal mental health challenges not only in the mothers but also in their partners and families/support systems.
Whereas the WHO has good recommendations on maternal mental health during the postnatal period, are these recommendations reflected in countries’ national policies and practice?
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